Insomnia is a prevalent sleep disorder increasingly recognized as a risk factor for cardiovascular diseases (CVDs). However, its causal relationship with myocardial infarction (MI) and its impact on coronary plaque vulnerability remain poorly understood.
We performed Mendelian randomization (MR) analysis using genome-wide association study (GWAS) summary data for insomnia (n = 462,341) and MI (n = 484,598) in populations of European descent. Additionally, 340 patients with coronary artery disease (CAD) underwent coronary angiography and optical coherence tomography (OCT) imaging. Insomnia was assessed by the Insomnia Severity Index (ISI), and OCT was used to evaluate plaque features including thin-cap fibroatheroma (TCFA), fibrous cap thickness, lipid arc, macrophage infiltration, and plaque rupture.
MR analysis showed a potential causal effect of genetically predicted insomnia on MI risk (OR = 1.015; 95% CI: 1.004–1.027; p = 0.007), with no evidence of pleiotropy or heterogeneity. Clinically patients with insomnia (ISI ≥ 8) had higher rates of hypertension (54.3% vs. 39.6%) and MI (32.4% vs. 21.7%), elevated CRP levels, and exhibited greater plaque vulnerability on OCT, including increased incidence of TCFA (29.5% vs. 17.0%), thinner fibrous caps, larger lipid arcs, and more frequent macrophage infiltration and plaque rupture. Logistic regression identified both insomnia (OR = 1.806; p = 0.037) and CRP (OR = 1.384; p = 0.034) as independent predictors of TCFA.
This study provides genetic and clinical evidence that insomnia contributes to MI risk and coronary plaque vulnerability, underscoring the importance of addressing sleep disturbances in CAD management.
Loop diuretic therapy (LDT) is associated with increased mortality in heart failure. Severe aortic stenosis (AS) patients are at risk for heart failure and frequently on LDT. We assessed cardiac structure and function, organ congestion, filling pressures, and long-term outcomes of severe AS patients on LDT undergoing aortic valve replacement (AVR).
Consecutive patients with severe AS with [n = 157; median (interquartile range) daily torasemide dose: 10 (5–15) mg] or without (n = 346) LDT undergoing a detailed assessment of congestion (B-type natriuretic peptide, liver enzymes, systematic chest X-ray analysis) and cardiac catheterization before AVR with a post-AVR follow-up of several years were studied.
Despite similar AS severity (indexed aortic valve area 0.41 ± 0.12 vs. 0.43 ± 0.12 cm2/m2) patients with LDT had more advanced biventricular remodeling and dysfunction, higher B-type natriuretic peptide [446 (245–991) vs. 150 (62–317) ng/L; p < 0.001], higher liver enzymes, higher chest x-ray congestion score [2 (1–4.5) vs. 1 (0–2) score points; p < 0.001], and higher mean right atrial pressure (8 ± 4 vs. 6 ± 3 mmHg) and mean pulmonary artery wedge pressure (21 ± 8 vs. 14 ± 6 mmHg; p < 0.001 for both) than those without. After a median post-AVR follow-up of 15 months functional capacity was worse, and estimated systolic pulmonary pressure was higher (37 ± 11 vs. 32 ± 8 mmHg; p < 0.001), and after a median follow-up of 44 months mortality was higher [hazard ratio 2.01 (95% confidence interval 1.17–3.77); p = 0.01] in LDT compared to non-LDT patients.
LDT identifies AS patients with more advanced cardiac remodeling, more severe congestion, unfavorable hemodynamics, impaired post-AVR status, and increased post-AVR long-term mortality.
Hypertension often coexists with dyslipidemia, requiring combination therapy. Telmisartan, combined with amlodipine or rosuvastatin, targets these conditions. This meta-analysis evaluates the efficacy and safety of these combinations in adults with hypertension and dyslipidemia.
A systematic search was conducted in Cochrane Central, MEDLINE/PubMed, ClinicalTrials.gov, and ScienceDirect (as of June 2024) for randomized controlled trials (RCTs) comparing telmisartan plus amlodipine versus telmisartan plus rosuvastatin in adults (≥ 18 years) with hypertension and dyslipidemia. A random-effects model was used with RevMan 5.4.1. The risk of bias and heterogeneity were assessed with the Cochrane Risk of Bias Tool and the I² statistic.
Three RCTs involving 320 participants were included. At 4 weeks, telmisartan + amlodipine yielded greater sSBP (sitting Systolic Blood Pressure) reduction compared to telmisartan + rosuvastatin (MD = −10.93 mmHg; 95% CI: −19.02 to −2.83; p = 0.008; I² = 70%). sDBP (sitting Diastolic Blood Pressure) reductions were greater in the amlodipine group at 8 weeks (MD = −8.59 mmHg; 95% CI: −13.35 to −3.82; p = 0.0004; I² = 58%). Conversely, LDL-C reduction was favored by telmisartan + rosuvastatin, with significant effects observed at both 4 weeks (MD = 85.98 mg/dL) and 8 weeks (MD = 79.75 mg/dL). TEAE incidence did not differ significantly (RR = 1.23; 95% CI: 0.75–2.04; p = 0.41; I² = 0%).
Telmisartan + amlodipine demonstrates superior antihypertensive efficacy, while telmisartan + rosuvastatin more effectively lowers LDL-C. Safety profiles are comparable. Findings support the selection of a regimen based on individualized therapeutic goals.
Atrial fibrillation-related stroke is a leading cause of morbidity and mortality. The comparative effectiveness and safety of left atrial appendage closure (LAAC) devices, compared with one another and with anticoagulation, is unclear.
We conducted a systematic review and network meta-analysis (NMA) of all clinical trials comparing the Watchman and Amplatzer Amulet LAAC devices with each other or with warfarin or direct oral anticoagulants (DOACs). The primary comparison was between LAAC devices with secondary comparisons to anticoagulation. The primary effectiveness outcomes were any stroke and all-cause death. Safety outcomes included any thromboembolism, device embolization, and pericardial effusion.
There were 476 articles identified from the search and 6 eligible RCTs were included (n = 3666). There was no difference in the risk of stroke with Amulet versus Watchman (RR = 1.48, 95% CI: 0.64–3.46, I2 = 41.3%), nor in the risk of death (RR = 1.00, 95% CI: 0.59–1.70, I2 = 45.0%). Risk of thromboembolism was not significantly different with Amulet versus Watchman (RR = 0.73, 95% CI: 0.18–2.97, I2 = 0%), nor was risk of device embolization (RR = 2.29, 95% CI: 0.71, 7.43, I2 = 0%). Both devices exhibited increased risk of pericardial effusion compared with warfarin, with Amulet at highest relative risk (RR = 27.08, 95% CI: 3.53–207.98, I2 = 0%) followed by Watchman (RR = 12.79, 95% CI: 1.73–94.85, I2 = 0%). Amulet also carried higher relative risk of pericardial effusion than Watchman (RR = 2.12, 95% CI: 1.45–3.09).
In this NMA, the Amulet and Watchman LAAC devices were associated with similar risks for stroke, mortality, thromboembolism, and device embolization. Pericardial effusion risk was higher with Amulet than Watchman.
Electrical storm is a life-threatening condition commonly observed in patients with structural heart disease. While catheter ablation has emerged as an effective treatment for electrical storm, the long-term outcomes are still unknown. This study aims to evaluate the long-term outcomes of catheter ablation in patients with electrical storm, focusing on mortality, ventricular tachycardia (VT) recurrence, and hospitalization rates.
We conducted a retrospective cohort study at a single center, enrolling 65 patients admitted with electrical storm. All patients underwent catheter ablation The primary outcome was VT-related ICD therapies, while the secondary outcomes included all caused mortality, VT-related ICD therapies, repeat ablation, hospitalization, and stroke.
The cohort was predominantly male (86.15%) with ischemic cardiomyopathy (56.92%) and a mean left ventricular ejection fraction (LVEF) of 35.3% ± 13%. All procedures were completed without any fatalities and without significant complications in 93.85% of cases. During follow-up, 22 patients (33.85%) received ICD therapies for VT. The median estimated survival time for the VT-free survival was 43 months. The 12-month mortality rate was 26.15%. Over the median follow-up of 23 months, 40% of patients died, and 72% experienced a composite endpoint of death, VT recurrence, or hospitalization. Multivariate analysis identified reduced LVEF as the strongest predictor of mortality during follow-up.
VT ablation is a safe and effective therapeutic option for managing electrical storm, providing high acute procedural success and allowing most patients to be discharged. However, this high-risk population remains at significant risk for long-term morbidity and mortality.
This study aimed to investigate the electrocardiographic characteristics, electrophysiological features, and outcomes of radiofrequency ablation in patients with focal atrial tachycardia (FAT) originating from the fossa ovalis (FO).
We retrospectively analyzed 67 patients with FAT originating from the FO and classified into two groups: the Unilateral Ablation Group (n = 36) and the Bilateral Ablation Group (n = 31). Patients in the Unilateral Ablation Group underwent ablation on the earliest single side, whereas patients in the Bilateral Ablation Group underwent ablation on both the right and left earliest sides. Ablation targets were guided by fluoroscopy, three-dimensional mapping, and intracardiac ultrasound. All patients were followed up for more than 1 year.
Out of 1914 patients with atrial tachycardia, 3.5% had FAT originating from the FO. Fifty-four patients were located at the superior area of the FO with positive P waves in inferior leads, while 13 patients were located at the inferior area of the FO with negative P waves in inferior leads. The recurrence rate of FAT was 16.6% in the Unilateral Ablation Group, but no recurrence occurred in the Bilateral Ablation Group during regular follow-up (p = 0.026). Among the six patients with recurrence, five underwent left-sided ablation and one underwent right-sided ablation. All recurrent cases were then ablated by a bilateral strategy. Follow-up showed no further recurrence.
Bi-atrial mapping is necessary for ablation of FAT arising from the FO. Bilateral ablation for FO AT appears to be more reasonable.
Despite technological advances, predicting atrial fibrillation (AF) recurrence after catheter ablation remains a clinical challenge. We developed a novel multi-parametric model integrating electrophysiological substrate characteristics, structural remodeling, and inflammatory/metabolic biomarkers to improve risk stratification.
This retrospective study analyzed 279 consecutive patients undergoing first-time AF ablation (June 2022 to January 2024) with 12-month follow-up. Using a 7:3 training-validation split, we identified independent predictors through multivariate logistic regression.
Four key parameters emerged as powerful predictors: low-voltage zone extent (LVZ), high-sensitivity C-reactive protein (hs-CRP), red cell distribution width (RDW), and left atrial diameter (LAD). The composite model showed exceptional discrimination (AUC, in the training set and 0.84 in the validation set), significantly outperforming both individual parameters (LAD AUC 0.77, LVZ 0.75) and the APPLE score (AUC: 0.73, p < 0.001). The model stratified patients into five distinct risk categories (recurrence risk < 5% to > 70%) with strong clinical utility.
This is the first East Asian study to integrate voltage mapping with hematological-inflammatory biomarkers, providing a cost-effective and precise tool for post-ablation management. The model's performance and generalizability support its adoption in precision medicine pathways, particularly for guiding substrate modification in high-risk patients.
Evidence supporting catheter ablation (CA) for atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFpEF) is limited. This study evaluated the impact of CA on clinical outcomes in patients with AF and HFpEF using a global clinical database.
The TriNetX research network identified patients aged ≥ 18 years with AF and HFpEF (February 2014 to June 2024). Patients were categorized by whether they underwent CA for AF. Primary outcomes included all-cause mortality, heart failure (HF) with acute exacerbation, and ischemic stroke. Secondary outcomes included progression to mildly reduced or reduced ejection fraction (EF) during follow-up.
Patients receiving CA showed lower incidences of all-cause mortality, HF exacerbation, and ischemic stroke. There was a trend of less patients with progression to reduced EF in patients with CA. The reduction in mortality was consistent across all subgroups, while stroke reduction was more significant in females, those with better EF, without chronic kidney disease (CKD) or diabetes mellitus (DM), with hypertension (HTN), and with paroxysmal AF. The benefits in reducing HF exacerbation were particularly notable in females, those with better EF, without CKD, and with HTN.
In patients with AF and HFpEF, CA provided cardiovascular and cerebral benefits and might reduce the risk of progression to HFrEF over 5 years of follow-up. Additionally, CA was associated with a reduction in all-cause mortality in patients with AF and HFpEF.
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